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This is VAERS ID 293334

Case Details

VAERS ID: 293334 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Female  
Location: Alabama  
Vaccinated:2007-09-19
Onset:2007-09-28
   Days after vaccination:9
Submitted: 2007-10-09
   Days after onset:11
Entered: 2007-10-16
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08690K / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Intestinal functional disorder, Intussusception, Ultrasound abdomen
SMQs:, Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific inflammation (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Omnicef
Current Illness: Ear infection
Preexisting Conditions: Ventral hernia. PMH: multiple ear infections.
Allergies:
Diagnostic Lab Data: Abd sonar. Labs and diagnostics: US abd (10/3/07) shows a transient small bowel intussusception which resolved during the course of the study. US abd (10/5/07) again showed a transient small bowel intussusception in the RUQ. Abd X-ray 10/11/07 with a non-obstructive gas pattern. US abd (10/11/07) no IS. C-diff toxin (-).
CDC Split Type:

Write-up: Severe intestinal irritability with U/S documented small bowel intussusception. 11/26/2007 MR received for several OV with ped surgeon and ped gastroenterology beginning 10/03/2007 to 11/08/07 operative report for ventral hernia repair. Child presented to ped surgeon on 10/03/2007 with c/o significant diarrhea as well as blood in stool. Seen again 10/5/07 for irritability and abdominal pain. DX: irritable bowel 2'' disrupted bowel flora. GI visit 10/18/07 with assessment: Constipation. Milk Allergy. Diarrhea. Abdominal pain. Ventral hernia. Ventral hernia repair on 11/08/07. 12/10/2007 Vaqx record received from PCP. Corresponds with VAERS report.


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